Clinical dialogues with expectant parents often include a
discussion about harvesting the newborn's umbilical cord blood and
stem cells. Stem cell discussions and controversies are part of the
medical landscape, as evidenced by the 2005 Stem Cell Therapeutic and
Research Act, which expanded the bone marrow registry program to also
include cord blood. (1) Currently, cord blood cells are used in the
treatment of thalassemia, sickle cell and other hematologic disorders,
immune deficiencies, and metabolic disorders; they are also used in
oncology. Overall, results using cord blood stem cells are comparable to
those achieved with bone marrow transplants, although cord blood stem
cell use is associated with decreased graft-vs-host disease. (2)

We have to ask ourselves, however, what will medicine look like 10
or 20 years from now? Will advances in the field of regenerative
medicine produce new and viable treatments for common diseases? If so,
cord blood will likely play a vital role in many of these challenging
areas.

New avenues of clinical investigation underscore the potential
importance of umbilical cord stem cells and their efficacy in human
subjects. (3) Recently, cord blood stem cells have shown potential to
"transform" into specific differentiated cell types and
develop into organ-specific tissue. (4) As a result, researchers are
evaluating the usefulness of these cells in repair of damage caused by
myocardial infarction, diabetes mellitus, stroke, traumatic brain
injury, and spinal cord injury, among others. (5-17) At present, the
likelihood of children needing their own cord blood stem cells for
autologous transplant is controversial. Available estimates range from 1
in 1000 to 1 in 200,000, (18) but these estimates are premature, given
the infancy of autologous banking.

Certainly, health care providers should inform prospective parents
about public and private cord banking options. The authors of the
American College of Obstetricians and Gynecologists "Committee
Opinion: Routine Storage of Umbilical Cord Blood for Potential Future
Transplantation" noted the encouraging results of cord blood stem
cell transplants and discussed scientific, legal, and ethical issues
associated with cord blood banking. The issues of public versus private
banking were addressed, primarily regarding how to help patients
realistically evaluate the potential future use of cord blood at that
point in time. While many of the questions raised remain with us,
considerable advances in the field and tantalizing results of small
trials suggest that the uses of cord blood stem cells in humans will
continue to expand.

A 2007 report from the National Guideline Clearing House (19) notes
that physicians should be familiar with the rationale for cord blood
banking, available options, and the potential costs of current storage
options. Physicians should counsel prospective parents about the
potential uses and contraindications of cord blood, and be able to
educate patients about the pros and cons of public and private banks.

A recent report from the American Academy of Pediatrics (AAP) (20)
supports the use of private cord blood storage when a full sibling has a
medical condition (malignant or genetic) and could benefit from cord
blood transplantation. Otherwise, the AAP recommends the use of public
banking, but notes the importance of educating parents about the
potential complications of banking, specifically that the cord blood
banked with a public institution may not be available for private use.
The report also specifically notes that underserved minorities (African
American, Hispanic, American Indian/Alaska Native individuals) should be
recruited to improve supplies of matches for these populations.

This publication seeks to provide a clear picture of the uses and
contraindications of privately stored cord blood at this point in time
and provide a resource with which clinicians can effectively counsel
their patients.

References

(1.) The White House News Page. President signs "Stem Cell
Therapeutic and Research Act of 2005."
www.whitehouse.gov/news/releases/2005/12/20051220-1.html. Accessed
September 27, 2007.